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NPI Code Detail

MEDICARE: CHERLEIGH CARPENTER EDD, LICSW, LADC, MH

MEDICARE: CHERLEIGH CARPENTER EDD, LICSW, LADC, MH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent Psychologist390200000XMN
21041C0700XClinical Social Worker27427MN
3101YM0800XMental Health CounselorMN
4390200000XStudent in an Organized Health Care Education/Training ProgramSEE-103TC2200XMN
5101YA0400XAddiction (Substance Use Disorder) Counselor307009MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11558800136OTHERMNNPI

General Provider Information

NPI Number : 1558800136
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERLEIGH CARPENTER EDD, LICSW, LADC, MH
Provider Business Mailing Address
First Line : 5500 NICOLLET AVE UNIT 19321
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55419-1991
Country : US
Telephone Number : 612-767-8671
Fax Number : 612-827-1215
Provider Business Practice Location Address
First Line : 3333 N 4TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-2615
Country : US
Telephone Number : 612-767-8671
Fax Number : 612-827-1215
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2017
Last Update Date : 01/21/2026

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